| Abdomen 2 views (74019) |
$258.30 |
$369 |
2.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,545.60 |
$2,208 |
4.2× |
| Ankle 2 views (73600) |
$251.30 |
$359 |
3.1× |
| Arthrogram hip (73525) |
$543.20 |
$776 |
1.7× |
| Arthrogram shoulder (73040) |
$607.60 |
$868 |
1.9× |
| Arthrogram wrist (73115) |
$261.10 |
$373 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$787.50 |
$1,125 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$996.80 |
$1,424 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,346.80 |
$1,924 |
3.7× |
| Bone age studies (77072) |
$156.10 |
$223 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$1,294.30 |
$1,849 |
3.5× |
| Bone survey complete (77075) |
$1,388.10 |
$1,983 |
14.4× |
| Cervical spine 2 or 3 views (72040) |
$318.50 |
$455 |
4.0× |
| Chest 1 view (71045) |
$132.30 |
$189 |
1.7× |
| Chest 3 views (71047) |
$135.10 |
$193 |
1.7× |
| Clavicle complete (73000) |
$245 |
$350 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$746.20 |
$1,066 |
7.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$686.70 |
$981 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$665.70 |
$951 |
3.0× |
| CT abdomen w contrast (74160) |
$604.80 |
$864 |
3.7× |
| CT abdomen w wo contrast (74170) |
$1,504.30 |
$2,149 |
9.3× |
| CT abdomen w/o contrast (74150) |
$1,183 |
$1,690 |
12.3× |
| CT angiography upper extremity lt (73206) |
$746.90 |
$1,067 |
4.6× |
| CT c-spine w/o contrast (72125) |
$665.70 |
$951 |
6.9× |
| CT cervical spine w&w/o contrast (72127) |
$746.90 |
$1,067 |
4.6× |
| CT cervical spine with contrast (72126) |
$598.50 |
$855 |
1.9× |
| CT chest w/wo contrast (71270) |
$686.70 |
$981 |
4.3× |
| CT chest with contrast (71260) |
$1,171.10 |
$1,673 |
7.3× |
| CT head/brain with contrast (70460) |
$987 |
$1,410 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,060.50 |
$1,515 |
6.6× |
| CT iac w contrast (70481) |
$610.40 |
$872 |
3.8× |
| CT lower ext w/o (73700) |
$1,199.10 |
$1,713 |
12.5× |
| CT lower extremity w wo contrast (73702) |
$746.90 |
$1,067 |
4.6× |
| CT lower extremity with contrast (73701) |
$1,302 |
$1,860 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$754.60 |
$1,078 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,139.60 |
$1,628 |
11.9× |
| CT lumbar spine with contrast (72132) |
$1,344 |
$1,920 |
4.2× |
| CT maxillofacial w contrast (70487) |
$604.10 |
$863 |
3.7× |
| CT maxillofacial w/o contrast (70486) |
$1,010.80 |
$1,444 |
10.5× |
| CT maxillofacial w/wo contrast (70488) |
$746.90 |
$1,067 |
4.6× |
| CT neck soft tissue w contrast (70491) |
$598.50 |
$855 |
3.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$754.60 |
$1,078 |
4.7× |
| CT orbits w/o contrast (70480) |
$1,127 |
$1,610 |
11.7× |
| CT pelvis w & w/o contrast (72194) |
$1,303.40 |
$1,862 |
8.1× |
| CT pelvis w/o contrast (72192) |
$1,034.60 |
$1,478 |
10.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,358.70 |
$1,941 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$604.80 |
$864 |
6.3× |
| CT thoracic spine w/contrast (72129) |
$598.50 |
$855 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$604.80 |
$864 |
6.3× |
| CT thoracic spine w/wo contrast (72130) |
$746.90 |
$1,067 |
4.6× |
| CT thorax w/o contrast (71250) |
$945 |
$1,350 |
9.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$746.90 |
$1,067 |
4.6× |
| CT upper extremity w/o contrast rt (73200) |
$604.80 |
$864 |
6.3× |
| CT upper extremity with contrast (73201) |
$598.50 |
$855 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,964.90 |
$2,807 |
12.2× |
| Cta Abdomen (74175) |
$1,988.70 |
$2,841 |
12.3× |
| CTA abdomen pelvis (74174) |
$1,754.20 |
$2,506 |
5.5× |
| CTA chest (71275) |
$1,236.90 |
$1,767 |
7.7× |
| Cta Head (70496) |
$1,628.90 |
$2,327 |
10.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$765.80 |
$1,094 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,750 |
$2,500 |
10.8× |
| Cta Neck (70498) |
$1,827.70 |
$2,611 |
11.3× |
| Cta Pelvis (72191) |
$746.90 |
$1,067 |
4.6× |
| Cystography minimum 3 views rs&i (74430) |
$681.10 |
$973 |
2.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$274.75 |
$392.50 |
2.9× |
| Esophagus (74220) |
$471.10 |
$673 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$464.80 |
$664 |
4.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$425.60 |
$608 |
4.4× |
| Fluoroscopy up to 1 hr (76000) |
$418.60 |
$598 |
1.9× |
| Foot 2 views (73620) |
$260.40 |
$372 |
3.3× |
| Forearm 2 views (73090) |
$255.50 |
$365 |
3.2× |
| Gated Heart Planar Single (78472) |
$1,465.10 |
$2,093 |
4.0× |
| Hand 2 views (73120) |
$262.50 |
$375 |
2.7× |
| Hand 3 views (73130) |
$322 |
$460 |
4.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,293.60 |
$1,848 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,046.50 |
$1,495 |
2.8× |
| Ht muscle image spect sing (78451) |
$1,960.70 |
$2,801 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$268.10 |
$383 |
3.3× |
| Kidney imaging morphology (78700) |
$676.90 |
$967 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,340.50 |
$1,915 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,615.60 |
$2,308 |
3.2× |
| Knee 3 views (73562) |
$234.50 |
$335 |
2.9× |
| Meckels Diverticulum (78290) |
$423.50 |
$605 |
1.2× |
| MRA head w & w/o contrast (70546) |
$612.50 |
$875 |
1.9× |
| MRA head w/o contrast (70544) |
$618.80 |
$884 |
2.8× |
| MRA head with contrast (70545) |
$612.50 |
$875 |
1.9× |
| MRA neck w contrast (70548) |
$612.50 |
$875 |
1.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$612.50 |
$875 |
1.9× |
| MRA neck w/o contrast (70547) |
$612.50 |
$875 |
2.8× |
| MRI abdomen w contrast (74182) |
$907.90 |
$1,297 |
2.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,680 |
$2,400 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$907.90 |
$1,297 |
4.1× |
| MRI any jnt lwr ext with con lt (73722) |
$907.90 |
$1,297 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$907.90 |
$1,297 |
1.3× |
| MRI c-spine with contrast (72142) |
$907.90 |
$1,297 |
2.8× |
| MRI cervical spine w/o contrast (72141) |
$907.90 |
$1,297 |
4.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,680 |
$2,400 |
5.2× |
| MRI chest w/o contrast (71550) |
$907.90 |
$1,297 |
4.1× |
| MRI chest with contrast (71551) |
$907.90 |
$1,297 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$907.90 |
$1,297 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$907.90 |
$1,297 |
2.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$907.90 |
$1,297 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$907.90 |
$1,297 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,680 |
$2,400 |
5.2× |
| MRI orbit/face/neck w/contrast (70542) |
$907.90 |
$1,297 |
2.8× |
| MRI pelvis w contrast (72196) |
$907.90 |
$1,297 |
2.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,680 |
$2,400 |
5.2× |
| MRI pelvis w/o contrast (72195) |
$907.90 |
$1,297 |
4.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,680 |
$2,400 |
5.2× |
| MRI scan of leg joint before and after contrast (73723) |
$1,680 |
$2,400 |
5.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,680 |
$2,400 |
5.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,680 |
$2,400 |
5.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$907.90 |
$1,297 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$907.90 |
$1,297 |
2.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,680 |
$2,400 |
5.2× |
| MRI thoracic spine w/o contrast (72146) |
$907.90 |
$1,297 |
4.1× |
| MRI tmj (70336) |
$907.90 |
$1,297 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$907.90 |
$1,297 |
4.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,680 |
$2,400 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$907.90 |
$1,297 |
4.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,499.40 |
$2,142 |
1.3× |
| Neck soft tissue (70360) |
$256.20 |
$366 |
3.2× |
| Nm gastric emptying study (78264) |
$1,456.70 |
$2,081 |
4.0× |
| Osseous survey limited (77074) |
$557.90 |
$797 |
5.8× |
| Parathyroid imaging (78070) |
$1,135.40 |
$1,622 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$148.40 |
$212 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,680 |
$2,400 |
5.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$914.90 |
$1,307 |
2.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,288 |
$1,840 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$507.50 |
$725 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$70 |
$100 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$518 |
$740 |
5.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$314.30 |
$449 |
3.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$338.10 |
$483 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$239.40 |
$342 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$168 |
$240 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$239.40 |
$342 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$245.70 |
$351 |
3.1× |
| Radiological examination surgical specimen (76098) |
$381.50 |
$545 |
0.8× |
| Ribs bilateral 3 views (71110) |
$357 |
$510 |
3.7× |
| Scapula complete (73010) |
$240.10 |
$343 |
2.5× |
| Screening digital breast tomosynthesis (77063) |
$127.40 |
$182 |
5.4× |
| Small bowel series (74250) |
$652.40 |
$932 |
4.0× |
| Spine thoracic 3 views (72072) |
$299.60 |
$428 |
3.1× |
| Thoracolumbar 2 views (72080) |
$359.10 |
$513 |
4.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$539 |
$770 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$420.70 |
$601 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$366.80 |
$524 |
3.8× |
| Unlisted Ultrasound Procedure (76999) |
$616.70 |
$881 |
7.7× |
| Urethrocystography retrograde rs&i (74450) |
$590.10 |
$843 |
2.7× |
| Urethrocystography voiding (74455) |
$676.20 |
$966 |
3.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$665.70 |
$951 |
4.1× |
| Us abdl aorta screen aaa (76706) |
$428.40 |
$612 |
4.5× |
| Us breast unilateral complete (76641) |
$408.80 |
$584 |
4.3× |
| Us breast unilateral limited (76642) |
$337.40 |
$482 |
4.2× |
| Us chest (76604) |
$403.20 |
$576 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$475.30 |
$679 |
4.9× |
| Us kidney transplant (76776) |
$812 |
$1,160 |
8.4× |
| Us ob detailed single fetus (76811) |
$247.80 |
$354 |
1.1× |
| Us ob transvaginal (76817) |
$372.05 |
$531.50 |
3.9× |
| Us pelvic non ob complete (76856) |
$605.50 |
$865 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$343.70 |
$491 |
3.6× |
| Us pregnancy ltd (76815) |
$423.50 |
$605 |
4.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$502.60 |
$718 |
5.2× |
| Us retroperitoneal complete (76770) |
$465.50 |
$665 |
4.8× |
| Us retroperitoneal limited (76775) |
$233.10 |
$333 |
2.4× |
| Us scrotum and contents (76870) |
$557.20 |
$796 |
5.8× |
| Us soft tissue head/neck (76536) |
$492.10 |
$703 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$408.10 |
$583 |
4.2× |
| Wrist 2 views (73100) |
$189 |
$270 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$350 |
$500 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$196.70 |
$281 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$174.30 |
$249 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$266.70 |
$381 |
3.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$311.50 |
$445 |
3.9× |
| X-ray exam hip uni 1 view (73501) |
$175 |
$250 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$250.60 |
$358 |
3.1× |
| X-ray exam of femur 1 (73551) |
$207.90 |
$297 |
2.6× |
| X-ray eye for foreign body (70030) |
$168 |
$240 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$326.90 |
$467 |
3.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$240.80 |
$344 |
3.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$209.65 |
$299.50 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$235.90 |
$337 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$262.50 |
$375 |
3.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$422.80 |
$604 |
4.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$135.10 |
$193 |
1.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$154.70 |
$221 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$197.40 |
$282 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$745.50 |
$1,065 |
7.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$253.40 |
$362 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$347.90 |
$497 |
3.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$221.20 |
$316 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$238 |
$340 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$539.70 |
$771 |
5.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$268.80 |
$384 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$308 |
$440 |
3.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$210.70 |
$301 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$293.30 |
$419 |
3.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$173.60 |
$248 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$455 |
$650 |
4.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$308 |
$440 |
3.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$266.70 |
$381 |
3.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$264.60 |
$378 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$176.40 |
$252 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$318.50 |
$455 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$430.50 |
$615 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$205.80 |
$294 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$161.70 |
$231 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$577.50 |
$825 |
6.0× |
| Xr chest 4+ views (71048) |
$154 |
$220 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$133.70 |
$191 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$101.50 |
$145 |
1.1× |
| Xr shoulder 1 view (73020) |
$204.40 |
$292 |
2.6× |
| Xr spine cervical 4 or 5 views (72050) |
$430.50 |
$615 |
4.5× |
| Xr tibia/fibula 2 views (73590) |
$221.20 |
$316 |
2.8× |
| Xr tmj bilateral (70330) |
$108.50 |
$155 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$126.70 |
$181 |
1.6× |